Public Health Emergency Coming To An End, Raising Questions About Home Health Regulatory Flexibilities

The COVID-19 public health emergency (PHE) is finally coming to an end, the Biden administration announced Monday. Its final day will be May 11.

It — and the special home health regulatory flexibilities that have come with it — will have been active by over three years at that point, dating back to January 2020.

“The COVID-19 national emergency and public health emergency were declared by the Trump Administration in 2020,” the White House Office of Management and Budget said in a statement. “They are currently set to expire on March 1 and April 11, respectively. At present, the administration’s plan is to extend the emergency declarations to May 11, and then end both emergencies on that date. This wind-down would align with the administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”

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A federally declared emergency allows agencies like the Centers for Medicare & Medicaid Services (CMS) the ability to grant regulatory flexibilities. 

For home health providers, multiple flexibilities were granted. Therefore, the end of the PHE will have a handful of ripple effects.

During the PHE, agencies were generally able to forego face-to-face requirements for things like onboarding, training and even certifying home-based care services. Telehealth flexibilities were also granted, though home health providers still don’t have the ability to bill for those visits as they would an in-person visit.

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The Acute Hospital Care at Home waiver was originally tied to the PHE as well. But like some other health care-related flexibilities, it was given an extension of two years past the expiration of the PHE in the year-end, $1.66 trillion spending bill. Providers are also allowed to use telehealth as a replacement for certain face-to-face requirements through 2024 thanks to the bill.

While the PHE declaration had a massive effect on home health care – and home- and community-based care, generally – during the pandemic, it was also a cause for confusion for providers at times. 

Because it was active for so long, there are now “veteran” home health workers who have never gone a day without PHE-era regulations in place.

For instance, one waiver made it possible for multiple professional disciplines to conduct home health admissions based on the needs of the patient. That could be continued, but now hangs in the balance.

“These workers, they came into home health at the same time as the waiver, ”Cindy Krafft, the co-owner and co-founder of the consulting firm Kornetti & Krafft Health Care Solutions, told Home Health Care News in July. “What they think is routine — being a PT and doing the admission or being a nurse and not needing to always do it — may be a bit of a rude awakening. It’s normal to them, but this is technically a waiver that is going to go away at some point.”

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